Create Your Own Certainty
Government Restructuring + Decision Paralysis = Continued Uncertainty
Significant and multi-generational changes are taking place across all of federal government. All of this change is creating a cacophony of noise, disruption, and destruction. It is near impossible, even for the most optimistic of us to see the positive benefits of all this noise, disruption, and destruction.
Last week, it was announced that SAMHSA would be significantly reduced in size and budget AND be rolled under a new umbrella agency (???).
A new Administration for a Healthy America (AHA) will consolidate the OASH, HRSA, SAMHSA, ATSDR, and NIOSH, so as to more efficiently coordinate chronic care and disease prevention programs and harmonize health resources to low-income Americans. Divisions of AHA include Primary Care, Maternal and Child Health, Mental Health, Environmental Health, HIV/AIDS, and Workforce, with support of the U.S. Surgeon General and Policy team.
It’s unclear what parts of SAMHSA are to be saved and what parts will be excised.
Will the Office of Recovery remain?
Will SAMHSA continue the NSDUH surveying?
Why does any of this matter?
Whether it is SAMHSA or any significant agency in the federal government, communities, organizations, and individuals have built systems and dependencies on SAMHSA’s existence and, most recently, its positive changes and impact.
An abrupt change, especially at this scale, endangers lives.
That’s not hyperbole.
The recovery process from mental illness and addictions is fickle and fraught with pitfalls. Immediately ceasing funding, technical support, and human connections leaves already vulnerable people open to greater risk of failure.
No matter how you look at it, this is morally suspect.
One can be in favor of deep changes to government for greater efficiency and cost saving AND support a methodical and well-articulated strategy and change process.
None of the latter is happening.
Over the last five to seven years, we have begun to see the needle moving in the right direction in terms of overdose deaths. We reached a plateau of 111,466 reported drug overdose deaths in June 2023. As of October 2024, the reported overdose death total was 82,020, a 25% decrease over 12 months.
Only two states in the union saw an increase in overdose deaths, Nevada and Utah (and who knows what’s happening in South Dakota because they don’t like to report in a timely manner).
Source: CDC: https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
Following this one metric … clearly we’ve turned a corner. The data is telling us to keep doing what we’re doing.
Look, I could navigate into a tangent about the proper role and scope of the federal government and intended reliances on government (taxpayer) money, but that’s for another time.
We’ve had an untenable addiction crisis in the U.S. for far too long. We’ve needed greater investment, innovation, and ingenuity to move the needle. The problem is so big, and the U.S. is so big, there needs to be a national organizing theory of change and collective action. We started to get some of that. The Office of Recovery appeared to be that driving national force and the widespread distribution of Naloxone appeared to be a collective action with demonstrable impact.
But organizations, communities, and individual leaders continue to seek answer from on high for funding and outcomes guidance. The latter has been a blackhole, leaving organizations to bow to the dictate of insurance companies and status quo vanity metrics.
We do not need a homogenized field, but we do need to agree on a few things, like what is a shared definition of recovery success and what are the data that feeds the recovery definition of success.
And since there’s no Moses with a stone tablet and 10 dictates, measuring success or adding data for program accountability remains elusive.
What remains is continued uncertainty.
In the coming months, more people will lose their jobs and organizations will shut down. Granted, some organizational closure might be a net benefit because (a) they weren’t sustainable in the first place, and (b) they probably weren’t performing very well either.
But, that does not mean you should cower and quit.
What should happen is that individual organizations need to own their success determination. Now is the time to get granular and figure out what really matters to you, aligns with your mission, and generates revenue for sustainability. You can decide for yourself what to measure and what not to measure. Who are you accountable to? Your clients and your stakeholders. Measure what matters to them and it will matter to you.
The second thing you can do is establish a local collaborative. Identify three to five likeminded organizations and get in a room to establish a set of shared metrics. Each returns to the operations and optimizes for those metrics — and the others that singularly matter to your organization. Meet quarterly, review the results, and compare notes: what worked, what didn’t. Adjust. Repeat.
Create your own certainty.
Look, the current leadership of the United States is unserious and lacks vision.
That, however, is the opportunity. Ignore the noise. Find your signal.
